Provider Demographics
NPI:1073948022
Name:HEARTLAND HEARING CENTERS, LLC
Entity Type:Organization
Organization Name:HEARTLAND HEARING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-0555
Mailing Address - Street 1:202 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1705
Mailing Address - Country:US
Mailing Address - Phone:573-756-0555
Mailing Address - Fax:573-756-0556
Practice Address - Street 1:307 HENRY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6326
Practice Address - Country:US
Practice Address - Phone:618-610-5551
Practice Address - Fax:618-433-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty